Changes to Healthcare Scientist Training and More in Belfast - Janet Chestnut
A report on the Joint Spring Meeting of the ACB Northern Ireland Region and ACB Ireland held in April 2011
The venue for this year’s ACB/ACBI joint meeting was once again the Radisson Hotel situated on the site of the old gasworks in Belfast. There was a good attendance from laboratories North and South of the border.
Paul Newland, Consultant Clinical Scientist at Alder Hey Childrens Hospital, focussed on new guidelines for diabetic ketoacidosis (DKA) issued by the British Society for Paediatric Endocrinology and Diabetes (BSPED) in 2009. The main change from previous guidelines was the recommendation to use capillary blood ketone levels in monitoring. Blood ketone meters measure beta hydroxybutyrate which forms the greater proportion of ketones present in DKA and is physiologically more relevant than acetoacetate detected by the older urine ketone dipstick test.
Betahydroxybutyrate is now available in many hospitals as a POCT and this makes turnaround time for these tests much faster, enabling more effective monitoring of patients and more accurate adjustment of their fluid and insulin regimes. An online calculator for estimating fluid requirements when treating children with DKA was illustrated. Ward¬based ketone meters can also be used for monitoring ketone levels in children with epilepsy being treated with a ketogenic diet.
Dr James Shand, SpR from the Southern Trust Cardiology Department, considered high sensitivity Troponin T (hsTNT), a test which has only recently become available and is now being introduced in many laboratories. He explained the clinical benefits of this test over the old less sensitive troponin assays and gave a guide to the interpretation of results. In patients with chest pain, serial sampling is important to improve specificity. One benefit of the test is that many patients previously classified as unstable angina are now found to have NSTEMI and treated appropriately, improves the prognosis. HsTNT has been shown to be significantly associated with CVD risk factors and any measurable TNT is associated with adverse prognosis.
We turned our attention to the proposed changes in training and career structure for Healthcare Scientists. This was explained by Professor Bernie Hannigan, Chief Scientific Advisor for Northern Ireland. She emphasised that the new Healthcare Scientist is seen as part of a multidisciplinary team and that ideally local workforce planning requirements should determine recruitment. A curriculum for an MSc in Clinical Science has been developed by the Modernising Scientific Careers Team in conjunction with Working Groups from the appropriate Professions. Commissioning for providers for this MSc course as part of the Scientist Training Programme is underway. Professor Hannigan also discussed the fact that benchmarking with Great Britain had highlighted significant under¬representation of Healthcare Scientists in Northern Ireland as a percentage of total Health Service workforce numbers and in terms of training budget allocated per capita to this group.
The afternoon session was chaired by Liz McClean and began with Barry Sampson, Principal Biochemist at Charing Cross Hospital. The topic was the application of trace element analysis to monitoring metal¬on¬metal hip prostheses. It has been increasingly recognised that these hip prostheses can release cobalt and chromium when damaged by wear and tear. The metals leak into periarticular tissue and eventually are detected in the blood.
High levels in blood are associated with a high level of erosion and may indicate a need for revision surgery. Some confusion has occurred in the popular press due to misinterpretation of the term pseudotumour coined by researchers to describe the radiological appearance of collections seen in some prosthetic joints. These are entirely benign and not related to any risk of cancer as feared.
Standardisation of serum calcium adjustment was discussed by Mrs Annette Thomas, from WEQAS. Many hospitals have started reporting albumin adjusted calcium. WEQAS surveys show that most hospitals are still using the traditional equation for correction Caadj = Catot + (40¬Alb)x0.02 quoted in many textbooks but with little evidence for validity over the range of methods. This may lead to varying results for adjusted calcium depending on methods used for both albumin and calcium. It is recommended that each laboratory should ideally now derive their own equation using linear regression on local results.
POCT Eire Style
Ruth O’Kelly from Coombe Womens Hospital in Dublin discussed Point of Care services in the Republic of Ireland. She outlined some of the advantages and disadvantages of POCT and emphasized the importance of laboratory involvement in the selection and use of tests. A recent survey audited accreditation status, POCT committees, and quality management systems as recommended by recently introduced guidelines. The survey found that many hospitals do not have a committee to plan and oversee the delivery of POCT services, to ensure that users are trained and that appropriate quality control is in place.
Margaret McDonnell, from the regional Endocrine Laboratory in Belfast Trust, gave the final talk of the day addressing the topical question of whether or not to screen for vitamin D deficiency. Concern about vitamin D deficiency in the UK has been increasing and consequently the number of serum vitamin D levels requested has been increasing. Vitamin D deficiency has been postulated to have a role in various conditions from cancer to multiple sclerosis but the evidence so far in most cases is inconclusive and firm evidence for the effect of vitamin D supplementation in preventing these conditions is also lacking. It was concluded that widespread screening for vitamin D deficiency is not yet justified.
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